Topical compositions

ABSTRACT

The disclosure provides a topical gel formulation comprising 1-1.5 wt. % clindamycin phosphate, 2.5-3.5 wt. % benzoyl peroxide, and 0.1-0.2 wt. % adapalene, in combination with a gelling agent, a polyhydric alcohol, and water, useful in treating inflammatory skin conditions, including acne, together with methods of making and using the same.

This application claims priority to U.S. Provisional Application No. 62/881,836, filed Aug. 1, 2019, the contents of which are incorporated herein by reference in its entirety.

FIELD

This disclosure relates to topical compositions for the treatment of dermatological conditions, including acne. In particular, the disclosure provides topical compositions comprising three different active ingredients, and methods for making and using the same.

BACKGROUND

Acne is a very common disorder of sebaceous follicles that is most prevalent among teenagers, usually triggered by the increase in androgen production occurring at puberty. Although acne generally resolves by the age of 25, approximately 3% to 8% of adults 25 to 44 years of age present with acne. The pathogenesis is complex and appears to involve 4 primary features: stimulation of sebum gland activity, bacterial proliferation (especially Cutibacterium acnes, previously known as Propionibacterium acnes), abnormal follicular hyperkeratinization and resultant obstruction of the sebaceous follicles, and the release of inflammatory mediators. These changes in acne patients result in the formation of clinical inflammatory lesions including superficial pustules such as comedones (popularly known as “blackheads” or “whiteheads”) and more deeply located papules, nodules, and cysts. The areas most affected by the disease include the pilosebaceous follicles of the head and upper trunk, where the sebaceous glands are particularly active.

Elevated production of oily sebum and keratin, leading to acne, is influenced by individual genetics, a wide variety of medications (e.g., corticosteroids, androgens, or lithium, azathioprine, haloperidol, Vitamin D, Vitamin B12, halogens such as iodides or bromides, phenytoin, or phenobarbital), and possibly other factors, such as diet and stress. Elevated sebum and keratin production correlates with elevated levels of various hormones, including androgens (e.g., testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA)), growth hormone (GH), and insulin-like growth factor 1 (IGF-1). Infection of the follicle by anaerobic bacteria (e.g. C. acnes) and/or by the parasitic mite Demodex folliculorum may exacerbate the condition, although whether infection is involved in initiating the condition is unclear.

Current treatment options for acne include (i) retinoids and retinoid-like drugs, such as tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage); antibiotics, including clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin); salicylic acid and azelaic acid; and dapsone (Aczone)

Benzoyl peroxide is commonly found in over-the-counter products to treat acne, and prescription products in combination with antibiotics. While the exact mechanism of action is unclear, it is bacteriocidal, it breaks down keratin, thereby helping to unclog the pores, and it may inhibit sebum production. Benzoyl peroxide formulations, however, may cause local irritation, both because benzoyl peroxide is a powerful oxidant, and because, being nearly insoluble in water, it is often formulated with harsh organic solvents. It is also incompatible with many other compounds, due to its high chemical reactivity.

Clindamycin for topical administration may be administered in the form of clindamycin phosphate, a phosphate ester prodrug of clindamycin. In addition to its antibiotic effects, clindamycin has anti-inflammatory effects. One disadvantage of clindamycin (and other antibiotics) is the risk of developing antibiotic-resistant bacterial populations on the skin.

Adapalene is a retinoid compound that is an agonist for specific retinoic acid nuclear receptors. It modulates cellular differentiation, keratinization, and inflammatory processes, and topical formulations have been approved for treating acne. Although the exact mode of action of adapalene is unknown, it may normalize the differentiation of follicular epithelial cells, resulting in decreased microcomedone formation.

Combination products have been tried, but the results have been quite unpredictable. For example, Bowman, S. et al., “Comparison of clindamycin/benzoyl peroxide, tretinoin plus clindamycin, and the combination of clindamycin/benzoyl peroxide and tretinoin plus clindamycin in the treatment of acne vulgaris: a randomized, blinded study.” J Drugs Dermatol. 2005 September-October; 4 (5):611-8, reported that while regimens that included clindamycin/benzoyl peroxide were more effective than a retinoid (tretinoin) plus clindamycin in treating acne, there was no clinical advantage to adding a retinoid plus clindamycin to once-daily clindamycin/benzoyl peroxide treatment. Similar results were seen in a large trial studying a combination treatment with a benzoyl peroxide 5%/clindamycin 1% gel and a different retinoid, tazarotene. Clinical Trial NCT00713609, results posted March 2017, available on clinicaltrials.gov. After 12 weeks, there were no statistically significant differences between active combination treatment groups in lesion count reduction. The triple combination was no better and in fact had numerically lower reduction in lesion counts, compared to dual therapies. Often, such combination therapies are administered with one or two drugs in the morning and the other drug or drugs in the evening, which is less convenient for the patients than a single daily treatment, but may reduce unpredictable detrimental interactions among the drugs.

While various treatments for acne are known, there is still a need for more effective treatments. The lack of understanding and consensus regarding both the complex pathogenesis of the condition and the precise mechanism(s) of action of common treatment agents make it difficult to design effective treatments and demonstrating efficacy and lack of side effects requires expensive clinical trials. Simply increasing the concentration of existing active agents may result in irritation and other side effects. Combinations of active agents may be constrained due to unpredictable chemical interactions between the agents, unpredictable effects of one agent on the delivery of another agent, unpredictable efficacy, and potential for unpredictable side effects. There is a need for improved formulations to treat acne, providing better efficacy without unacceptable side effects.

SUMMARY

We have surprisingly found that a topical gel containing a fixed combination of benzoyl peroxide, clindamycin phosphate, and adapalene, administered on a daily basis, provides significantly enhanced efficacy compared to gels containing combinations of any two of these agents.

Each of these agents has some degree of anti-inflammatory activity; both the benzoyl peroxide and the clindamycin phosphate decrease C. acnes proliferation); benzoyl peroxide is also keratolytic; and adapalene additionally regulates keratinization (Zaenglein 2008). A fixed-dose combination treatment is optimal to enhance patient adherence due to simplified application regimens (e.g., once daily versus sequential morning/evening administration of each active agent) and also to preclude substance incompatibilities due to application errors (e.g., oxidation by using incompatible single agents). Whether such a fixed dose formulation could be designed to be stable, safe and effective, however, required empirical testing.

The disclosure provides, in one embodiment, a topical gel formulation comprising 1-1.5 wt. % (e.g., about 1.2 wt. %) clindamycin phosphate, 2.5-3.5 wt. % (e.g., about 3.1 wt. %) benzoyl peroxide, and 0.1-0.2 wt. % (e.g., about 0.15 wt. %) adapalene, in combination with a gelling agent (e.g., a carbomer homopolymer), a polyhydric alcohol (e.g., propylene glycol), and water.

In another embodiment, the disclosure provides a method of treating acne vulgaris comprising administering to the affected area, e.g., once daily, e.g., for at least 12 weeks, a topical gel formulation comprising 1-1.5 wt. % (e.g., about 1.2 wt. %) clindamycin phosphate, 2.5-3.5 wt. % (e.g., about 3.1 wt. %) benzoyl peroxide, and 0.1-0.2 wt. % (e.g., about 0.15 wt. %) adapalene, in combination with a gelling agent (e.g., a carbomer homopolymer), a polyhydric alcohol (e.g., propylene glycol), and water.

In another embodiment, the disclosure provides a method of making a topical gel formulation, e.g., as described above, comprising mixing 1-1.5 wt. % (e.g., about 1.2 wt. %) clindamycin phosphate, 2.5-3.5 wt. % (e.g., about 3.1 wt. %) benzoyl peroxide, 0.1-0.2% (e.g., about 0.15 wt. %) adapalene, gelling agent (e.g., a carbomer homopolymer), a polyhydric alcohol (e.g., propylene glycol), and water, to form a dispersion, and then adjusting the pH of the combination to pH 5-6.

Further areas of applicability of the present disclosure will become apparent from the detailed description provided hereinafter. It should be understood that the detailed description and specific examples, while indicating the preferred embodiment of the invention, are intended for purposes of illustration only and are not intended to limit the scope of the invention.

DETAILED DESCRIPTION

The following description of the preferred embodiment(s) is merely exemplary in nature and is in no way intended to limit the invention, its application, or uses.

In a first embodiment, the disclosure provides a topical gel formulation (Formulation 1) comprising 1-1.5 wt. % clindamycin phosphate, 2.5-3.5 wt. % benzoyl peroxide, and 0.1-0.2 wt. % adapalene, a gelling agent, a polyhydric alcohol, and water; for example,

-   -   1.1. Formulation 1 wherein the concentration of clindamycin         phosphate is about 1.2 wt. %.     -   1.2. Formulation 1 or 1.1 wherein the concentration of benzoyl         peroxide is about 3.1 wt. %.     -   1.3. Any foregoing formulation wherein the concentration of         adapalene is about 0.15 wt. %.     -   1.4. Any foregoing formulation wherein the gelling agent is         selected from hydroxypropylcellulose, hydroxyethylcellulose,         carboxyvinyl polymers (optionally crosslinked with allyl ethers         of polyalcohols, e.g., carbomers), carboxyvinyl copolymers,         polyacrylates, acrylate copolymers, acrylamide/sodium         acryloyldimethyltaurate copolymers, polyvinyl alcohols,         polyethylene oxides, propylene glycol alginates,         methylcellulose, hydroxypropylmethylcellulose, xanthan gum,         carrageenan gum, and combinations thereof.     -   1.5. Any foregoing formulation wherein the gelling agent is         selected from carboxyvinyl polymers (optionally crosslinked with         allyl ethers of polyalcohols, e.g., carbomers), carboxyvinyl         copolymers, polyacrylates, acrylate copolymers,         acrylamide/sodium acryloyldimethyltaurate copolymers, propylene         glycol alginates, hydroxypropylmethylcellulose, and xanthan gum.     -   1.6. Any foregoing formulation wherein the gelling agent         comprises acrylamide/sodium acryloyldimethyltaurate copolymer.     -   1.7. Any foregoing formulation wherein the gelling agent         comprises acrylamide sodium         acryloyldimethyltaurate/isohexadecane/polysorbate 80 gelling         agent.     -   1.8. Any foregoing formulation wherein the gelling agent         comprises a carbomer homopolymer, crosslinked with allyl ethers         of polyalcohols (e.g., allyl sucrose or allyl pentaerythritol).     -   1.9. Any foregoing formulation wherein the gelling agent is a         polymer of acrylic acid cross-linked with allyl ethers of         polyalcohols; e.g., containing from 56% to 68% of carboxylic         acid (—COOH) groups; e.g., having a viscosity of 40,000-60,000         cPs (measured at 0.5 wt % at pH 7.5).     -   1.10. Any foregoing formulation wherein the gelling agent is a         carbomer homopolymer Type C, e.g., as defined by the United         States Pharmacopeia/National Formulary (USP/NF) monograph, e.g.,         Carbopol 980.     -   1.11. Any foregoing formulation wherein the amount of gelling         agent is 1.5-2 wt. %.     -   1.12. Any foregoing formulation wherein the amount of gelling         agent is about 1.75 wt. %.     -   1.13. Any foregoing formulation wherein the amount of gelling         agent is carbomer homopolymer Type C, in an amount of about 1.75         wt. %.     -   1.14. Any foregoing formulation wherein the pH of the         formulation is pH 5-6.     -   1.15. Any foregoing formulation wherein the gelling agent is a         crosslinked polymer comprising carboxy moieties and wherein the         formulation further comprises base selected from potassium         hydroxide, sodium hydroxide and combinations thereof in an         amount sufficient to deprotonate the carboxy moieties         sufficiently to cause the gelling agent to thicken.     -   1.16. Any foregoing formulation comprising a base selected from         potassium hydroxide, sodium hydroxide and combinations thereof         in an amount to provide a pH of 5-6.     -   1.17. Any foregoing formulation comprising a potassium hydroxide         in an amount to provide a pH of 5-6.     -   1.18. Any foregoing formulation wherein a fraction of the         benzoyl peroxide is undissolved and wherein the undissolved         fraction of the benzoyl peroxide is homogeneously dispersed in         the formulation.     -   1.19. Any foregoing formulation wherein a fraction of the         benzoyl peroxide is undissolved and wherein the undissolved         fraction of the benzoyl peroxide has a mean particle between 1         and 50 microns, e.g., between 2.5 and 30 microns.     -   1.20. Any foregoing formulation wherein the benzoyl peroxide is         not encapsulated or entrained in a microsponge.     -   1.21. Any foregoing formulation wherein the benzoyl peroxide is         free and unrestricted by any complex or polymer.     -   1.22. Any foregoing formulation wherein a fraction of the         adapalene is undissolved and wherein the undissolved fraction of         the adapalene is homogeneously dispersed in the formulation.     -   1.23. Any foregoing formulation wherein a fraction of the         adapalene is undissolved and homogeneously dispersed in the         formulation and a fraction of the benzoyl peroxide is also         undissolved and homogeneously dispersed in the formulation.     -   1.24. Any foregoing formulation wherein the adapalene and the         benzoyl peroxide do not undergo any substantial chemical         reaction with one another.     -   1.25. Any foregoing formulation wherein the polyhydric alcohol         is selected from propylene glycol, ethoxydiglycol, polyethylene         glycol (e.g., PEG 400), glycerol, and combinations thereof.     -   1.26. Any foregoing formulation wherein the polyhydric alcohol         is selected from 1,2-propylene glycol and 1,3-proylene glycol.     -   1.27. Any foregoing formulation wherein the polyhydric alcohol         is 1,2-propylene glycol.     -   1.28. Any foregoing formulation wherein the amount by weight of         polyhydric alcohol in the formulation is between one and four         times (e.g. one to two times) the amount of benzoyl peroxide.     -   1.29. Any foregoing formulation wherein the ratio by weight of         water to polyhydric alcohol in the formulation is 10:1 to 20:1.     -   1.30. Any foregoing formulation wherein the amount of polyhydric         alcohol is 3-7 wt. %.     -   1.31. Any foregoing formulation wherein the amount of polyhydric         alcohol is about 5 wt. %.     -   1.32. Any foregoing formulation wherein the polyhydric alcohol         is propylene glycol in an amount of about 5 wt. %.     -   1.33. Any foregoing formulation wherein the amount of water is         80% to 90% by weight, e.g. 85% to 90% by weight.     -   1.34. Any foregoing formulation wherein the formulation         comprises about 1.2 wt. % clindamycin phosphate, about 3.1 wt. %         benzoyl peroxide, and about 0.15 wt. % adapalene.     -   1.35. Any foregoing formulation wherein the formulation         comprises         -   about 1.2 wt. % clindamycin phosphate,         -   about 3.1 wt. % benzoyl peroxide,         -   about 0.15 wt. % adapalene,         -   about 5 wt. % propylene glycol,         -   about 1.75 wt. % carbomer homopolymer Type C,         -   potassium hydroxide in an amount to provide a pH of 5-6, and         -   water.     -   1.36. A formulation comprising about 1.2 wt. % clindamycin         phosphate, about 3.1 wt. % benzoyl peroxide, and about 0.15 wt.         % adapalene, wherein the formulation is clinically bioequivalent         to the preceding formulation, e.g., demonstrated by one or more         of (a) a clinical endpoint bioequivalence study, (b) in vitro         permeation testing (IVPT), and/or (c) in vitro release testing         (IVRT).     -   1.37. Any foregoing formulation, wherein the formulation is free         of ionic surfactants.     -   1.38. Any foregoing formulation, wherein the formulation is free         of organic solvents other than the polyhydric alcohol.     -   1.39. Any foregoing formulation wherein the formulation contains         less than 2% of ethanol or isopropanol, e.g. is free of ethanol         and isopropanol.     -   1.40. Any foregoing formulation wherein the formulation is         substantially free of monohydric alcohols.     -   1.41. Any foregoing formulation wherein the formulation is         aqueous.     -   1.42. Any foregoing formulation wherein the formulation is         monophasic.     -   1.43. Any foregoing formulation wherein the formulation is not         an emulsion.     -   1.44. Any foregoing formulation wherein the formulation does not         contain mineral oil.     -   1.45. Any foregoing formulation, wherein the formulation is free         of polymers other than the gelling agent.     -   1.46. Any foregoing formulation, wherein the formulation is free         of polymers other than carbomer homopolymer.     -   1.47. Any foregoing formulation, wherein the formulation is free         of preservatives or antimicrobial agents, other than the benzoyl         peroxide and the adapalene.     -   1.48. Any foregoing formulation, wherein the only active         ingredients are clindamycin phosphate, benzoyl peroxide, and         adapalene.     -   1.49. Any foregoing formulation further comprising one or more         additional inactive ingredients selected from humectants,         emollients, pH stabilizing agents, preservatives, chelating         agents, and anti-oxidants.     -   1.50. Any foregoing formulation further comprising an effective         amount of a preservative, e.g., selected from         parahydroxybenzoate preservatives (parabens), for example,         selected from methylparaben, propylparaben, and combinations         thereof.     -   1.51. Any foregoing formulation which is prepared by mixing         1-1.5 wt. % clindamycin phosphate, 2.5-3.5 wt. % benzoyl         peroxide, 0.1-0.2 wt. % adapalene, a gelling agent, a polyhydric         alcohol, and water, to form a homogeneous dispersion, and then         adding a base selected from potassium hydroxide, sodium         hydroxide and combinations thereof in an amount to provide a pH         of 5-6.     -   1.52. Any foregoing formulation wherein the clindamycin         phosphate, benzoyl peroxide, and adapalene are present in         concentrations effective to treat acne when the formulation is         administered once daily to the affected area over a period of at         least four, six or eight weeks, e.g., at least 12 weeks.     -   1.53. Any foregoing formulation, wherein the formulation has         fewer side effects than a formulation comprising 2.5-3.5 wt. %         benzoyl peroxide and 0.1-0.2 wt. % adapalene.     -   1.54. Any foregoing formulation, wherein the formulation does         not have significantly more side effects than a formulation         comprising 2.5-3.5 wt. % benzoyl peroxide and 0.1-0.2 wt. %         adapalene.     -   1.55. Any foregoing formulation, wherein the formulation is more         effective in treating acne than a formulation comprising active         ingredients selected from (i) 1-1.5 wt. % clindamycin phosphate         and 2.5-3.5 wt. % benzoyl peroxide, (ii) 2.5-3.5 wt. % benzoyl         peroxide and 0.1-0.2 wt. % adapalene, and (iii) 1-1.5 wt. %         clindamycin phosphate and 0.1-0.2 wt. % adapalene.     -   1.56. Any foregoing formulation wherein the formulation is         stable at room temperature for at least six weeks, e.g., at         least 10 weeks.     -   1.57. Any foregoing formulation wherein the formulation is         stable when refrigerated, e.g. at 2° C. to 8° C. (36° F. to 46°         F.), prior to dispensing to patient, then stable at room         temperature, e.g. at or below 25° C. (77° F.), for at least six         weeks, e.g., at least 10 weeks.     -   1.58. Any foregoing formulation for use in treating acne, e.g.,         by daily topical application to the affected area, e.g., in         accordance with any of Method 1, et seq.     -   1.59. Any foregoing formulation, which is obtained or obtainable         by the process of any of Methods 2, et seq.

In another embodiment, the disclosure provides a drug product, which is container containing any of Formulations 1-1.59, e.g., a pump container or a deformable tube containing any of Formulations 1-1.59, e.g., a container comprising a pump and containing any of Formulations 1-1.59, wherein the pump is calibrated to release a specific amount (e.g., 0.5-1 cubic centimeter, e.g., a pea-sized portion) of the formulation each time the pump is pressed.

In another embodiment, the disclosure provides a method (Method 1) of treating acne vulgaris in a patient in need thereof, comprising administering to the affected area on at least a daily basis, a topical gel formulation comprising 1-1.5 wt. % (e.g., about 1.2 wt. %) clindamycin phosphate, 2.5-3.5 wt. % (e.g., about 3.1 wt. %) benzoyl peroxide, and 0.1-0.2 wt. % (e.g., about 0.15 wt. %) adapalene, a gelling agent (e.g., a carbomer homopolymer), a polyhydric alcohol (e.g., propylene glycol), and water. For example, the disclosure provides:

-   -   1.1. Method 1, wherein administration is once daily.     -   1.2. Method 1 or 1.1, wherein the affected area is the face,         neck, back, and/or chest.     -   1.3. Any foregoing method wherein the affected area is the face.     -   1.4. Any foregoing method wherein the administration is to the         entire affected area, e.g., to the entire face.     -   1.5. Any foregoing method wherein a thin layer of the topical         gel formulation is once daily in the evening, at least 30         minutes prior to bed time, at about the same time every day, to         the entire face for twelve weeks.     -   1.6. Any foregoing method wherein the amount of topical gel         formulation is used per application is approximately 0.5-1 cubic         centimeters (a pea-sized amount).     -   1.7. Any foregoing method, wherein the patient is at least 9         years of age.     -   1.8. Any foregoing method, wherein the patient has a clinical         diagnosis of moderate to severe acne.     -   1.9. Any foregoing method wherein the patient has acne with a         score of 3 or 4 based on the following Evaluator's Global         Severity Score (EGSS):

Score Grade Description 0 Clear Normal, clear skin with no evidence of acne vulgaris 1 Almost Rare non-inflammatory lesions present, with clear rare non-inflamed papules (papules must be resolving and may be hyperpigmented, though not pink-red) 2 Mild Some non-inflammatory lesions are present, with few inflammatory lesions (papules/pustules only; no nodulocystic lesions) 3 Moderate Non-inflammatory lesions predominate, with multiple inflammatory lesions evident: several to many comedones and papules/pustules, and there may or may not be one nodulocystic lesion 4 Severe Inflammatory lesions are more apparent, many comedones and papules/pustules, there may or may not be up to two nodulocystic lesions

-   -   1.10. Any foregoing method, wherein the treatment continues for         at least 4 weeks, e.g., at least 8 weeks, e.g., at least 12         weeks.     -   1.11. Any foregoing method wherein the treatment continues for         at least 12 weeks.     -   1.12. Any foregoing method wherein the treatment is for a time         sufficient to ameliorate the symptoms of the inflammatory skin         condition.     -   1.13. Any foregoing method wherein the inflammatory skin         condition is acne vulgaris and the treatment results in an         improved score on the Evaluator's Global Severity Score (EGSS).     -   1.14. Any foregoing method, wherein the administration is once         daily in the evening.     -   1.15. Any foregoing method wherein the treatment has fewer side         effects than treatment with a formulation comprising 2.5-3.5 wt.         % benzoyl peroxide and 0.1-0.2 wt. % adapalene, e.g., lower         incidence of pain and/or dryness at the application site.     -   1.16. Any foregoing method, wherein the treatment is more         effective in treating acne than treatment with a formulation         comprising active ingredients selected from (i) 1-1.5 wt. %         clindamycin phosphate and 2.5-3.5 wt. % benzoyl peroxide, (ii)         2.5-3.5 wt. % benzoyl peroxide and 0.1-0.2 wt. % adapalene,         and (iii) 1-1.5 wt. % clindamycin phosphate and 0.1-0.2 wt. %         adapalene.     -   1.17. Any foregoing method wherein the patient has 20 or more,         e.g., 20 to 40, inflammatory lesions on the face, and/or 25 or         more, e.g., 25-100, noninflammatory lesions on the face at the         start of treatment.     -   1.18. Any foregoing method wherein the patient has been         diagnosed with moderate to severe acne.     -   1.19. Any foregoing method wherein the patient has an EGSS of 3         (moderate) or 4 (severe) at the start of treatment.     -   1.20. Any foregoing method wherein the patient is age 9 and up.     -   1.21. Any foregoing method wherein the patient is age 12 and up     -   1.22. Any foregoing method wherein at the start of treatment the         patient has a facial acne inflammatory lesion (papules,         pustules, and nodules) count of no less than 30, but no more         than 100.     -   1.23. Any foregoing method wherein at the start of treatment the         patient has a facial acne non-inflammatory lesion (open and         closed comedones) count of no less than 35, but no more than         150.     -   1.24. Any foregoing method wherein the patient is female, is not         pregnant, and is using birth control during the entire treatment         period.     -   1.25. Any foregoing method, wherein the topical gel formulation         is a formulation selected from any one of Formulations 1-1.59.     -   1.26. Any foregoing method, wherein the topical gel formulation         comprises about 1.2 wt. % clindamycin phosphate, about 3.1 wt. %         benzoyl peroxide, and about 0.15 wt. % adapalene.     -   1.27. Any foregoing method, wherein the topical gel formulation         comprises         -   about 1.2 wt. % clindamycin phosphate,         -   about 3.1 wt. % benzoyl peroxide,         -   about 0.15 wt. % adapalene,         -   about 5 wt. % propylene glycol,         -   about 1.75 wt. % carbomer homopolymer Type C,         -   potassium hydroxide in an amount to provide a pH of 5-6, and         -   water.     -   1.28. Any foregoing method, wherein the topical gel formulation         is a formulation comprising about 1.2 wt. % clindamycin         phosphate, about 3.1 wt. % benzoyl peroxide, and about 0.15 wt.         % adapalene, wherein the formulation is clinically bioequivalent         to the preceding formulation, e.g., demonstrated by one or more         of (a) a clinical endpoint bioequivalence study, (b) in vitro         permeation testing (IVPT), and/or (c) in vitro release testing         (IVRT).

In another embodiment, the disclosure provides the use of clindamycin phosphate, benzoyl peroxide, and adapalene, in the manufacture of a medicament (e.g., a formulation according to any one of Formulation 1-1.59) for treatment of an inflammatory condition of the skin (e.g., in accordance with any of Method 1-1.19).

In another embodiment, the disclosure provides a method (Method 2) of making a topical gel formulation, e.g., any of Formulation 1-1.59, comprising

-   -   i. providing the following premixes:         -   a. Premix A comprising a dispersion of gelling agent in             water,         -   b. Premix B comprising a dispersion of benzoyl peroxide in             polyhydric alcohol and water,         -   c. Premix C comprising clindamycin phosphate in aqueous             solution,         -   d. Premix D comprising a dispersion of micronized adapalene             in polyhydric alcohol and water,     -   ii. mixing Premix A and Premix D,     -   iii. admixing Premix B to the mixture of step ii,     -   iv. admixing Premix C to the mixture of step iii,     -   v. adjusting the pH of the mixture of step iv to pH 5-6 to form         a gel.

For example, the disclosure provides

-   -   2.1. Method 2 wherein the gelling agent is selected from         hydroxypropylcellulose, hydroxyethylcellulose, carboxyvinyl         polymers (optionally crosslinked with allyl ethers of         polyalcohols, e.g., carbomers), carboxyvinyl copolymers,         polyacrylates, acrylate copolymers, acrylamide/sodium         acryloyldimethyltaurate copolymers, polyvinyl alcohols,         polyethylene oxides, propylene glycol alginates,         methylcellulose, hydroxypropylmethylcellulose, xanthan gum,         carrageenan gum, and combinations thereof.     -   2.2. Any foregoing method wherein the gelling agent is selected         from carboxyvinyl polymers (optionally crosslinked with allyl         ethers of polyalcohols, e.g., carbomers), carboxyvinyl         copolymers, polyacrylates, acrylate copolymers,         acrylamide/sodium acryloyldimethyltaurate copolymers, propylene         glycol alginates, hydroxypropylmethylcellulose, and xanthan gum.     -   2.3. Any foregoing method wherein the gelling agent comprises         acrylamide/sodium acryloyldimethyltaurate copolymer.     -   2.4. Any foregoing method wherein the gelling agent comprises         acrylamide sodium         acryloyldimethyltaurate/isohexadecane/polysorbate 80 gelling         agent.     -   2.5. Any foregoing method wherein the gelling agent comprises a         carbomer homopolymer, crosslinked with allyl ethers of         polyalcohols (e.g., allyl sucrose or allyl pentaerythritol).     -   2.6. Any foregoing method wherein the gelling agent is a polymer         of acrylic acid cross-linked with allyl ethers of polyalcohols;         e.g., containing from 56% to 68% of carboxylic acid (—COOH)         groups; e.g., having a viscosity of 40,000-60,000 cPs (measured         at 0.5 wt % at pH 7.5).     -   2.7. Any foregoing method wherein the gelling agent is a         carbomer homopolymer Type C, e.g., as defined by the United         States Pharmacopeia/National Formulary (USP/NF) monograph, e.g.,         Carbopol 980.     -   2.8. Any foregoing method wherein the polyhydric alcohol is         selected from propylene glycol, ethoxydiglycol, polyethylene         glycol (e.g., PEG 400), glycerol, and combinations thereof.     -   2.9. Any foregoing method wherein the polyhydric alcohol is         selected from 1,2-propylene glycol and 1,3-proylene glycol.     -   2.10. Any foregoing method wherein the polyhydric alcohol is         1,2-propylene glycol.     -   2.11. Any foregoing method wherein the amount of active         ingredient in the final product is about 1.2 wt. % clindamycin         phosphate, about 3.1 wt. % benzoyl peroxide, and about 0.15 wt.         % adapalene.     -   2.12. Any foregoing method wherein the topical gel formulation         thus produced comprises         -   about 1.2 wt. % clindamycin phosphate,         -   about 3.1 wt. % benzoyl peroxide,         -   about 0.15 wt. % adapalene,         -   about 5 wt. % propylene glycol,         -   about 1.75 wt. % carbomer homopolymer Type C,         -   potassium hydroxide in an amount to provide a pH of 5-6, and         -   water.     -   2.13. Any foregoing method wherein the pH of Premix C is         adjusted to pH 6-7, e.g., pH 6.2-6.8.     -   2.14. Any foregoing method wherein in step v, the pH is adjusted         to 5.4-5.8.     -   2.15. Any foregoing method wherein the pH adjusting agent is         selected from sodium hydroxide, potassium hydroxide and mixtures         thereof.     -   2.16. Any foregoing method wherein the pH adjusting agent is         potassium hydroxide.     -   2.17. Any foregoing method further comprising the step of         filling a dispensing container, e.g. a deformable tube or a pump         container, with the product of step v.

The disclosure further provides a topical gel formulation, e.g., according to any of Formulations 1-1.59, which is the product of any of Methods 2-2.17.

Unless stated otherwise, all percentages of composition components given in this specification are by weight based on a total composition or formulation weight of 100%.

The compositions and formulations as provided herein are described and claimed with reference to their ingredients, as is usual in the art. As would be evident to one skilled in the art, the ingredients may in some instances react with one another, so that the true composition of the final formulation may not correspond exactly to the ingredients listed. Thus, it should be understood that the invention extends to the product of the combination of the listed ingredients.

“About” with respect to an amount or a concentration means 80% to 120%, 90% to 110% of the claimed value.

As used throughout, ranges are used as shorthand for describing each and every value that is within the range. Any value within the range can be selected as the terminus of the range. In addition, all references cited herein are hereby incorporated by referenced in their entireties. In the event of a conflict in a definition in the present disclosure and that of a cited reference, the present disclosure controls.

Unless otherwise specified, all percentages and amounts expressed herein and elsewhere in the specification should be understood to refer to percentages by weight. The amounts given are based on the active weight of the material.

The invention is further illustrated in the following examples, which are meant to be exemplary and not limiting.

EXAMPLES Example 1: Clinical Trial Comparing Triple Combination with Double Combinations

This study is intended to evaluate the safety and efficacy of a novel, fixed-dose combination of clindamycin phosphate (CP), benzoyl peroxide (BPO), and adapalene (1.2%/3.1%/0.15%), relative to its vehicle and dual component combinations (BPO/Adapalene, clindamycin/BPO, and clindamycin/adapalene) for the treatment of moderate to severe acne vulgaris in subjects 9 years of age and older.

This is a multicenter, randomized, double-blind, vehicle-controlled, 12-week study designed to assess the safety, tolerability, and efficacy of combination of the triple combination gel containing clindamycin phosphate (CP), benzoyl peroxide (BPO), and adapalene (1.2%/3.1%/0.15%), relative to its vehicle and dual component combinations (BPO/Adapalene, clindamycin/BPO, and clindamycin/adapalene at weeks 2, 4, 8, and 12. The formulations tested are as follows:

TABLE 1 Test A: B: C: Gel Adap/BPO CP/BPO CP/Adap Vehicle Ingredient % w/w % w/w % w/w % w/w % w/w Clindamycin phosphate 1.2 1.2 1.2 a. Benzoyl peroxide, hydrous 3.1 3.1 3.1 (weight on anhydrous basis) Adapalene 0.15 0.15 0.15 Propylene glycol 5.0 5.0 5.0 5.0 5.0 Carbopol 980 (Carbomer 1.75 1.75 1.75 1.75 1.75 homopolymer) TiO2 0.25 Methylparaben 0.17 0.17 Propylparaben 0.03 Potassium hydroxide Qs pH Qs pH Qs pH Qs pH Qs pH 5.0-6.0 5.0-6.0 5.0-6.0 5.0-6.0 5.0-6.5 Purified Water qs to qs to qs to qs to qs to 100% 100% 100% 100% 100%

To be eligible for the study, subjects must be at least 9 years of age and have a clinical diagnosis of moderate to severe acne (defined as an Evaluator's Global Severity Score [EGSS, described above] of 3 or 4), presenting with 30-100 inflammatory facial lesions (papules, pustules, and nodules), 35-150 non-inflammatory facial lesions (open and closed comedones), and ≤2 facial nodules. All subjects receive once daily, topically applied treatment to the face for 12 weeks. Subject visits include Screening, Baseline, Week 2, Week 4, Week 8, and Week 12, at which safety and efficacy assessments are conducted (Screening and Baseline may occur on the same day if no washout is required). One pump of study drug is dispensed to the subjects at the Baseline, Week 4, and Week 8 study visits. Subjects are evaluated for drug usage compliance at each post baseline study visit (Weeks 2, 4, 8, and 12). Subjects apply their treatments at home, once daily (in the evening), as instructed by the study coordinator or designee at each study center.

The investigator assesses the subject's face at each study visit. Information on reported and observed adverse events (AEs) is obtained at each visit. An abbreviated physical examination and vital sign measurements is performed at Baseline and Week 12 (end of study) for all subjects. Blood samples are collected from subjects at Baseline and Week 12, for CBC/Diff and serum chemistry. For all female subjects of childbearing potential (FOCBP), urine pregnancy testing is performed at Screening, Baseline (prior to randomization), and at Weeks 2, 4, 8, and 12. Additionally, serum pregnancy testing is performed at Baseline and Week 12.

In addition, at selected study centers, standardized photography of the face is performed at Baseline, and Weeks 4, 8 and 12.

Approximately 750 subjects are randomized in a 1:1:1:1:1 ratio to the following treatment groups:

-   -   150 Subjects to Test Gel (clindamycin phosphate 1.2%/BPO         3.1%/adapalene 0.15%)     -   150 Subjects to Component A (BPO 3.1%/adapalene 0.15%)     -   150 Subjects to Component B (clindamycin phosphate 1.2%/BPO         3.1%)     -   150 Subjects to Component C (clindamycin phosphate         1.2%/adapalene 0.15%)     -   150 Subjects to Vehicle Gel

The assigned study drug is applied topically to the face once daily at home, in the evening, for 12 weeks (up to the evening prior to the Week 12 visit), with the exception of study visit days (Baseline, Week 2, 4 and 8) where study drug is applied (also by the subject) after the study visit is completed, at the investigational center.

Subjects meeting all of the following criteria are eligible for study entry:

-   -   1. Male or female at least 9 years of age and older.     -   2. Written and verbal informed consent must be obtained.         Subjects less than age of consent must sign an assent for the         study and a parent or a legal guardian must sign the informed         consent (if subject reaches age of consent during the study they         should be re-consented at the next study visit).     -   3. Subject must have an EGSS of 3 (moderate) or 4 (severe) at         the baseline visit.     -   4. Subjects with a facial acne inflammatory lesion (papules,         pustules, and nodules) count no less than 30, but no more than         100.     -   5. Subjects with a facial acne non-inflammatory lesion (open and         closed comedones) count no less than 35, but no more than 150.     -   6. Subjects with 2 or fewer facial nodules.     -   7. FOCBP1 and females who are premenses must be willing to         practice effective contraception for the duration of the study.         (Effective contraception is defined as stabilized on oral         contraceptive for at least 3 months, intrauterine device, condom         with spermicide, diaphragm with spermicide, implant, NuvaRing®,         injection, transdermal patch or abstinence.) Females on birth         control pills must have taken the same type pill for at least 3         months prior to entering the study and must not change type         during the study. Those who have used birth control pills in the         past must have discontinued usage at least 3 months prior to the         start of the study. Women who use birth control for acne control         only should be excluded.     -   8. Premenses females and FOCBP must have a negative urine         pregnancy test at the Screening Visit, and a negative urine         pregnancy test at the Baseline Visit.     -   9. Subjects must be willing to comply with study instructions         and return to the clinic for required visits. Subjects under the         age of consent must be accompanied by the parent or legal         guardian at the time of assent/consent signing.     -   10. If a cleanser, moisturizer or sunscreen is needed during the         study, subjects must be willing to use only allowed cleansers,         moisturizers, sunscreens, or moisturizer/sunscreen combination         products (see Appendix 17.2). The subject must agree to use         non-comedogenic products (including makeup and shaving         products).

Subjects meeting any of the following criteria are excluded from the study:

-   -   1. Use of an investigational drug or device within 30 days of         enrollment or participation in a research study concurrent with         this study.     -   2. Any dermatological conditions on the face that could         interfere with clinical evaluations such as acne conglobata,         acne fulminans, secondary acne, perioral dermatitis, clinically         significant rosacea, Gram-negative folliculitis, dermatitis,         eczema.     -   3. Any underlying disease(s) or some other dermatological         condition of the face that requires the use of interfering         topical or systemic therapy or makes evaluations and lesion         count inconclusive.     -   4. Subjects with a facial beard or mustache that could interfere         with the study assessments.     -   5. Subjects with more than two (2) facial nodules.     -   6. Evidence or history of cosmetic-related acne.     -   7. Subject has a history of experiencing significant burning or         stinging when applying any facial treatment (eg, makeup, soap,         masks, washes, sunscreens, etc) to their face.     -   8. Female subjects who are pregnant, nursing mothers, planning a         pregnancy during the course of the study, or become pregnant         during the study.     -   9. Use of estrogens (eg, Depogen, Depo-Testadiol, Gynogen,         Valergen, etc) for less than 12 weeks immediately preceding         study entry; subjects treated with estrogens 12 or more         consecutive weeks immediately prior to study entry need not be         excluded unless the subject expects to change dose, drug or         discontinue estrogen use during the study.     -   10. If female, subject has a history of hirsutism, polycystic         ovarian disease or clinically significant menstrual         irregularities.     -   11. History of regional enteritis, ulcerative colitis,         inflammatory bowel disease, pseudomembranous colitis, chronic or         recurrent diarrhea, or antibiotic-associated colitis.     -   12. Treatment of any type of cancer within the last 6 months,         with the exception of complete surgical excision of skin cancer         outside the treatment area.     -   13. Subject uses medications and/or vitamins during the study         which are reported to exacerbate acne (azathioprine,         haloperidol, Vitamin D, Vitamin B12, halogens such as iodides or         bromides, lithium, systemic or topical mid-to super-high potency         corticosteroids on the treatment area, phenytoin and         phenobarbital). Multivitamins, including Vitamin A, at         recommended daily doses, and Vitamin D at stable doses, are         acceptable.     -   14. History of hypersensitivity or allergic reactions to any of         the study preparations as described in the Investigator's         Brochure, including known sensitivities to any dosage form of         clindamycin phosphate, BPO, or adapalene.     -   15. Concomitant use of potentially irritating over-the-counter         products that contain ingredients such as BPO, alpha-hydroxy         acid, salicylic acid, retinol or glycolic acids.     -   16. Subjects who have not undergone the specified washout         period(s) for the following topical preparations or physical         treatments used on the face or subjects who require the         concurrent use of any of the following in the treatment area:         -   Topical astringents and abrasives (including comedone             removal strips) on the face: 1 week         -   Non-allowed moisturizers or sunscreens on the face: 1 week         -   Antibiotics on the face: 2 weeks         -   Other topical anti-acne drugs on the face: 2 weeks         -   Soaps containing antimicrobials on the face: 2 weeks         -   Anti-inflammatory agents and corticosteroids on the face: 4             weeks         -   Retinoids, including retinol on the face: 4 weeks         -   Facial procedures, including chemical peel,             microdermabrasion, light (PDT, LED) and laser therapy, and             acne surgery: 4 weeks     -   If the subject requires topical treatment for acne on areas         other than the face (e.g., chest and/or back), the investigator         may prescribe a product that does not contain clindamycin         phosphate, BPO, or adapalene, and must be noted in the source         documents and the electronic case report form (eCRF).     -   17. Subjects who have not undergone the specified washout         period(s) for the following systemic medications or subjects who         require the concurrent use of any of the following systemic         medications:         -   Corticosteroids (including intramuscular injections)(inhaled             corticosteroids are allowed): 4 weeks         -   Antibiotics: 4 weeks         -   Other systemic acne treatments: 4 weeks         -   Systemic retinoids: 6 months     -   18. Subject intends to use a tanning booth or sunbathe during         the study.     -   19. Subjects who are unable to communicate or cooperate with the         investigator due to language problems, poor mental development,         or impaired cerebral function.     -   20. Subjects with any underlying disease that the investigator         deems uncontrolled, and poses a concern for the subject's safety         while participating in the study.

Subject Withdrawal Criteria: Reasons for withdrawal may include, but are not limited to, the following:

-   -   Acne flare, as determined by the investigator, which requires         treatment with a disallowed therapy.     -   Either at the investigator's request, for tolerability reasons         (e.g., severe adverse reactions), or at the subject's request.     -   When the requirements of the protocol are not followed.     -   When a concomitant therapy likely to interfere with the results         of the study is reported or required by the subject (the         investigators report all such information on the source         documents/eCRFs and decide, in accordance with the Sponsor,         whether the subject is to be withdrawn).     -   When a subject is lost to follow-up. The investigators try twice         to reach the subject by telephone, email and/or text message,         and send a follow-up letter by certified mail before considering         that the subject is lost to follow-up. These actions are         reported on the End of Study source documents and the final         eCRF, and a copy of the follow-up letter is maintained in the         investigator's file.

All premature discontinuations and their associated reasons must be carefully documented by the investigator on source documents and the final eCRF, and, if need be, on the AE form. In any case, no subject who has been included and has an assigned study number can be replaced by another if the subject discontinues prematurely for whatever reason. All data gathered on the subject prior to termination is made available to the Sponsor.

Reasons for study completion/discontinuation as listed on the final report form are defined as follows:

-   -   Normal Study Completion—Subject completes the study as planned         in the protocol.     -   Adverse Event—Complete an AE form.     -   Death—Complete a serious adverse event (SAE) form.     -   Subject Request—Consent withdrawal, subject moved, schedule         conflicts.     -   Protocol Violation—Contact the Sponsor or designee before making         decision.     -   Lost to Follow-Up—Document with 2 phone calls, emails and/or         text messages, and a certified letter.     -   Pregnancy—Subject will discontinue study drug immediately, but         will be followed to term.     -   Complete a pregnancy form.     -   Worsening Condition—Subject requires alternate treatment for         acne before the end of the study and the investigator determines         it is not due to lack of efficacy     -   Lack of Efficacy—Subject requires alternate treatment for acne         after at least 2 weeks of study drug treatment and the risk of         continuing the subject in the study outweighs the benefit     -   as determined by the investigator.     -   Withdrawal by Parent/Guardian—An indication that the study         participant has been removed from the study by the parent or         legal guardian; includes consent withdrawal, subject     -   moves, schedule conflicts, etc.     -   Study Terminated by Sponsor—An indication that a clinical study         was stopped by its Sponsor.     -   Other—Specify in the comments section of the eCRF.

Criteria for Evaluation:

Primary Efficacy:

-   -   The co-primary efficacy endpoints are intended to compare the         numerical superiority of once daily application of Test Gel with         Vehicle Gel and each of the gel comparators (Components A, B and         C). Specifically, the endpoints to be summarized using         descriptive and inferential statistics are:     -   (1) Absolute change from Baseline to Week 12 in mean         inflammatory lesion counts.     -   (2) Absolute change from Baseline to Week 12 in mean         non-inflammatory lesion counts.     -   (3) Percent of subjects who achieve at least a 2-grade reduction         from baseline and are “clear” or “almost clear” at Week 12 based         on the Evaluator's Global Severity Score (EGSS).

Secondary Efficacy:

The secondary efficacy endpoints are intended to compare the numerical superiority of once daily application of Test Gel with Vehicle Gel and each of the gel comparators (Components A, B and C). Specifically, the secondary endpoints to be summarized using descriptive statistics are:

-   -   (1) Absolute change in inflammatory and non-inflammatory lesion         counts from baseline at Weeks 2, 4, and 8.     -   (2) Percent of subjects who achieve at least a 2-grade reduction         from baseline and are “clear” or “almost clear” at Week 2, 4,         and 8 based on the EGSS.     -   (3) Mean percent change in inflammatory and non-inflammatory         lesion counts from baseline at Weeks 2, 4, 8, and 12.

Efficacy Measurements:

Lesion Counts: At each visit, the evaluator counts the total number of inflammatory lesions (papules, pustules, and nodules) on the subject's face. Nodules are counted separately, but are included in the total inflammatory lesion count. At baseline, eligible subjects may have no more than 2 nodules. Nodules are included in the statistical analysis of inflammatory lesion counts. All inflammatory lesions are counted at the same time rather than counting papules and pustules separately. The evaluator also counts the total number of non-inflammatory lesions (open and closed comedones). The same blinded evaluator performs the lesion counts and EGSS evaluations at all visits from baseline to week 12 for the same subject.

Inflammatory lesions are defined as follows:

-   -   Papule—a small, solid elevation less than 5 mm in diameter. Most         of the lesion is above the surface of the skin.     -   Pustule—a small, circumscribed elevation less than 5 mm in         diameter that contains yellow-white exudate.     -   Nodule—a subcutaneous lesion greater than or equal to 5 mm in         diameter.

Non-inflammatory lesions are defined as follows:

-   -   Open comedones (black head)—a lesion in which the follicle         opening is widely dilated with the contents protruding out onto         the surface of the skin.     -   Closed comedones (white head)—a lesion in which the follicle         opening is closed, but the sebaceous gland is enlarged by the         pressure of the sebum build up, which in turn causes the skin         around the follicle to thin and become elevated with a white         appearance.

Evaluator's Global Severity Score (EGSS): At each visit, the severity is determined based on evaluator-blinded evaluations of the signs and symptoms of acne vulgaris. Every effort should be made to have the same evaluator assess the same subject at each visit. If this is not possible, the same evaluator should assess the subject at both the Baseline and Week 12 visits. Evaluations are scored on a scale of 0-4, with 0 being clear and 4 being severe:

TABLE 2 Score Grade Description 0 Clear Normal, clear skin with no evidence of acne vulgaris 1 Almost Rare non-inflammatory lesions present, with clear rare non-inflamed papules (papules must be resolving and may be hyperpigmented, though not pink-red) 2 Mild Some non-inflammatory lesions are present, with few inflammatory lesions (papules/pustules only; no nodulocystic lesions) 3 Moderate Non-inflammatory lesions predominate, with multiple inflammatory lesions evident: several to many comedones and papules/pustules, and there may or may not be one nodulocystic lesion 4 Severe Inflammatory lesions are more apparent, many comedones and papules/pustules, there may or may not be up to two nodulocystic lesions The EGSS should always be completed prior to the lesion counts.

Safety Measurements: Safety evaluations include the following:

-   -   The percent of subjects who experience a cutaneous reaction         (erythema, scaling, hypo/hyper-pigmentation, itching, burning,         or stinging) graded at a level of 3 at any point in the study         following the first application of study drug.     -   The percent of subjects who experience a cutaneous adverse event         (AE) irrespective of severity grade at any point in the study         following the first application of study drug.     -   Changes from baseline in all safety laboratory values and vital         sign measurements as summarized using descriptive statistics by         treatment group and study visit.     -   Subjects are assessed for the occurrence of new and ongoing AEs.

Cutaneous safety and tolerability are evaluated by tabulations of AEs and Cutaneous Safety and Tolerability Evaluation scores (scaling, erythema, hypo/hyper-pigmentation, itching, burning, and stinging) to be assessed at each study visit. Itching, burning and stinging (cutaneous tolerability) are reviewed with the subject at each study visit as an average over the period since the previous visit. Scaling, erythema, and hypo/hyper-pigmentation (cutaneous safety) are assessed by the evaluator at each visit. Cutaneous tolerability signs and symptoms that result in the subject requiring a concomitant therapy, interruption of treatment, or discontinuation from the study are reported as an AE.

Statistical Methods: All statistical processing are performed using SAS® version 9.3 or later unless otherwise stated.

Statistical significance is based on two-tailed tests of the null hypothesis resulting in p-values of 0.05 or less. P-values for selected variables are presented to assist the reviewer in evaluating the outcome of the study. Failure to achieve a statistically significant result at an alpha level of 0.05 does not imply a failed study.

The absolute change in mean inflammatory and non-inflammatory lesion counts from baseline to Week 12 is analyzed with an analysis of covariance (ANCOVA) with factors of treatment group and analysis center and a covariate of their respective baseline lesion count. A non-parametric analysis may be used. Additionally, 4 pairwise tests are conducted comparing the Test Gel to Vehicle Gel and Test Gel to each of the dual component gels.

The percent of subjects with treatment success, defined as at least a 2-grade improvement from baseline in the EGSS and an EGSS equating to “clear” or “almost clear”, are analyzed with a logistic regression test with factors of treatment group and analysis center and a covariate of baseline severity at Week 12. Four pairwise tests are conducted comparing the Test Gel to Vehicle Gel and Test Gel to each of the dual component gels.

The primary method of handling missing efficacy data is MCMC multiple imputation. Other methods, as well as the MCMC imputation, are specified in the statistical analysis plan which is finalized prior to data base lock.

Populations Analyzed and Treatment Groups: Inflammatory and non-inflammatory lesion counts are recorded for each subject at baseline and at Weeks 2, 4, 8, and 12. The absolute and percent change from baseline in inflammatory and noninflammatory lesions are derived for each subject at Weeks 2, 4, 8, and 12. The EGSS is recorded for each subject. The EGSS is dichotomized into “success” and “failure” with a subject considered a success if the EGSS at Weeks 2, 4, 8, and 12 is at least 2 grades less than baseline and achieving “clear” or “almost clear.” An intent-to-treat (ITT) analysis is conducted on all study subjects. The ITT population consists of all randomized subjects who received study drug. The safety population consists of all randomized subjects who are presumed to have used the study drug at least once and who provide at least 1 post-baseline evaluation. A per-protocol (PP) analysis is also conducted. Subjects are eligible for the PP analysis if they complete the 12-week evaluation without noteworthy study protocol violations (i.e., any subject or investigator activity that could have possibly interfered with the therapeutic administration of the treatment or the precise evaluation of treatment efficacy). The PP population includes subjects in the ITT population who do not meet any of the following criteria:

-   -   Failed any of the inclusion/exclusion criteria.     -   Have taken any interfering concomitant medications.     -   Did not attend the Week 12 visit, with the exception of a         discontinuation from the study due to an AE related to study         treatment or documented lack of treatment effect.     -   Missed more than 1 post baseline study visit prior to Week 12     -   Have not been compliant with the dosing regimen (i.e., subjects         may not miss more than 5 consecutive days of dosing and must         take 80%-120% of expected doses). The number of expected doses         is determined for each subject based on the length of their         participation in the study.     -   Out of visit window at the Week 12 visit.

Prior to breaking the blind, other additional criteria may be added to the list to accommodate for unforeseen events that occurred during the conduct of the trial that result in noteworthy study protocol violations.

Subject demographic and baseline characteristics are summarized by treatment group using descriptive statistics for the ITT, PP, and safety analysis sets.

Efficacy Evaluation—Primary: Co-primary efficacy analyses of the absolute change in inflammatory and in non-inflammatory lesions, from baseline, is conducted on the ITT population. The pre-specified time point is Week 12. Descriptive statistics are presented by treatment group for inflammatory and for non-inflammatory lesions as well as the absolute change in inflammatory and in non-inflammatory lesions. All of the testing relating to the analysis of inflammatory and non-inflammatory lesions uses the methods described above. The co-primary analysis of the dichotomized EGSS (success being at least a 2-grade improvement and achieving “clear” or “almost clear”) for the ITT population is based on the logistic regression test with factors of treatment group and analysis center and a covariate of baseline severity.

Efficacy Evaluation—Secondary: Mean percent change in inflammatory and non-inflammatory lesion counts from baseline, as well as proportion of subjects with at least a 2-grade improvement in the EGSS from baseline, is evaluated at Weeks 2, 4, 8, and 12.

Safety Evaluation: All subjects who receive medication and provide at least 1 post-baseline evaluation constitute the safety population. Safety is evaluated by tabulations of AEs, Cutaneous Safety and Tolerability Evaluations, vital signs/abbreviated physical examinations, and safety laboratory results. Cutaneous Safety and Tolerability Evaluation scores (erythema, scaling, hypo/hyper-pigmentation, itching, burning, and stinging) are presented with descriptive statistics at baseline and at Weeks 2, 4, 8, and 12 for each treatment group. Frequencies and percentages for each outcome category are included in these statistics. Mean values are presented graphically by week and treatment group. Vital sign measurements, an abbreviated physical examination, and safety laboratory results are conducted on all subjects at specified visits. For pre-menses females and FOCBP, urine pregnancy and serum pregnancy testing occur at specified visits. Changes from baseline in safety laboratory values and vital sign measurements are summarized with descriptive statistics for each treatment group at all applicable study visits. Shift tables are presented for changes in safety laboratory values to summarize laboratory test results collected at Baseline and Week 12. Normal ranges established by the central laboratory are used to determine the shifts. A listing of all out-of-range laboratory test results at any assessment time point is also be provided. Determination of clinical significance for all out-of-range laboratory values is made by each investigator and included in the listing. In addition, a listing of all clinically significant laboratory test results is provided.

All previous concomitant medications are classified based on terminology from the World Health Organization Drug Dictionary. Previous therapies and concomitant medications data are presented in the data listings. All AEs occurring during the study are recorded and classified using the Medical Dictionary for Regulatory Activities (MedDRA) terminology. Descriptions of AEs include the date of onset, the date the AE ended, the severity of the AE, the relationship to study drug, the action taken regarding study drug usage, the action taken to treat the AE, and the outcome. Adverse events are summarized by treatment group and severity. Each subject is counted only once within a system organ class or a preferred term

by using the AEs with the highest severity within each category. Adverse events are summarized by treatment group and relationship to study drug. Each subject is counted only once within a system organ class or a preferred term by using the AEs with the greatest relationship within each category. All information pertaining to AEs noted during the study is listed by subject, detailing the verbatim descriptions given by the investigator, preferred term, system organ class, start date, stop date, severity, actions taken, and drug relatedness. The AE onset is also be shown relative (in number of days) to the day of initial dose of the randomized study drug. Serious adverse events (SAEs) is tabulated by subject within treatment groups. In addition, a list of subjects who discontinued from the study and a list of subjects who experienced SAEs is also provided.

Subject Self-Assessments: Subjects are asked to complete an Acne-Specific Quality of Life Questionnaire during the study. The Investigator assessments (EGSS and lesion counts) are conducted independently of this subject self-assessment. Inferential statistical analysis is not performed on the questionnaire; the subjective responses are compared between treatment groups for trends.

This study is performed in compliance with Good Clinical Practice including the archiving of essential study documents. This protocol follows guidelines outlined by the International Conference for Harmonisation.

The clinical trial shows that the Test Gel is significantly more effective than vehicle or any of the three two-component comparators:

TABLE 3 Primary Efficacy Analysis: Absolute Change from Baseline in Lesion Counts and Dichotomized Global Severity at Week 12 (Intent-to-Treat Population) Test Gel A gel B gel C gel Vehicle (N = 146) (N = 150) (N = 146) (N = 150) gel Skewness Overall CP/BPO/Adap BPO/Adap CP/BPO CP/Adap (N = 148) P-Value P-Value Inflammatory Lesion Count - Absolute Change from Baseline LSMean^(a) −29.9 −26.7 −24.8 −26.8 −19.6 <0.001^(c) <0.001^(a) LSSD^(a) 11.86 11.74 11.71 11.69 12.12 <0.001^(d) Median^(b) −29.5 −27.2 −27.0 −26.8 −19.8 Min. to Max.^(b) −79 to 10 −67 to 6  −83 to 93 −74 to 2  −51 to 14 P-Value vs. Test Gel^(a) 0.021 <0.001 0.027 <0.001 P-Value vs. Test Gel^(d) 0.013 0.003 0.026 <0.001 Non-Inflammatory Lesion Count - Absolute Change from Baseline LSMean^(a) −35.5 −29.9 −27.8 −30.0 −21.8 <0.001^(c) <0.001^(a) LSSD^(a) 16.25 16.40 15.97 16.40 16.58 <0.001^(d) Median^(b) −33.6 −30.1 −29.8 −31.4 −23.5 Min. to Max.^(b) −94 to 5  −93 to 26 −65 to 30 −99 to 36 −76 to 39 P-Value vs. Test Gel^(a) 0.003 <0.001 0.004 <0.001 P-Value vs. Test Gel^(d) 0.004 <0.001 0.005 <0.001 Evaluator Global Severity Score - At Least Two Grade Reduction from Baseline and Clear or Almost Clear Success 52.5% 27.8% 30.5% 30.3% 8.1% N/A <0.001^(e) Failure 47.5% 72.2% 69.7% 69.7% 91.9% P-Value vs. Test Gel^(e) <0.001 0.001 0.001 <0.001 ^(a)Least squares means, standard deviations, contrast p-values and overall p-value from an analysis of covariance with factors of treatment group and analysis center and the respective baseline lesion count as a covariate. Values adjusted for multiple imputation. ^(b)Median, minimum and maximum represent average values, obtained from averaging the summary statistics generated from each imputed dataset. ^(c)Skewness test, assessed for each imputed dataset. The average p-value is presented. ^(d)Contrast p-values and overall p-value from a ranked analysis of covariance with factors of treatment group and analysis center and the respective baseline lesion count as a covariate. Values adjusted for multiple imputation. ^(e)Contrast p-values and overall p-value from a logistic regression with factors of treatment group and analysis center. Values adjusted for multiple imputation. Note: Multiple imputation (MCMC) used to impute missing values. Change calculated as Week 12-baseline.

Not only was the three-component Test Gel more effective than the two-component comparators, but it had fewer side effects than the benzoyl peroxide/adapalene combination:

TABLE 4 Summary of Treatment-Emergent Adverse Event Characteristics (Safety Population) Test Gel A gel B gel C gel Vehicle (N = 141) (N = 146) (N = 144) (N = 148) gel CP/BPO/Adap BPO/Adap CP/BPO CP/Adap (N = 146) Subjects reporting any adverse event 51 (36.2%) 52 (35.6%) 26 (18.1%) 40 (27.0%) 22 (15.1%) Subjects reporting any serious adverse event 1 (0.7%) 0 (0.0%) −0 (0.0%) −26.8 0 (0.0%) Subjects who died 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Subjects who prematurely discontinued study 4 (2.8%) 8 (5.5%) 0 (0.0%) 3 (2.0%) 2 (1.4%) drug due to an adverse event Subjects who prematurely discontinued from 4 (2.8%) 8 (5.5%) 0 (0.0%) 3 (2.0%) 1 (0.7%) the study due to an adverse event Total number of adverse events reported 90 96 35 74  30 By Subject Maximum severity Severe 7 (5%) 5 (3.4%) 0 (0.0%) 3 (2.0%) 1 (0.7%) Moderate 18 (12.8%) 22 (15.1%) 10 (6.9%) 17 (11.5%) 10 (6.8%) Mild 26 (18.4%) 25 (17.1%) 16 (11.1%) 20 (13.5%) 11 (17.5%) Strongest relationship to study drug Related 28 (19.9%) 32 (21.9%) 3 (2.1%) 18 (12.2%) 2 (1.4%) Not related 23 (16.3%) 20 (13.7%) 23 (16.0%) 22 (14.9%) 20 (13.7%) Maximum severity within relationship to study drug Related Severe 5 (3.5%) 5 (3.4%) 0 (0.0%) 1 (0.7%) 0 (0.0%) Moderate 10 (7.1%) 13 (8.9%) 0 (0.0%) 8 (5.4%) 1 (0.7%) Mild 13 (9.2%) 14 (9.6%) 3 (2.1%) 9 (6.1%) 1 (0.7%) Not related Severe 2 (1.4%) 0 (0.0%) 0 (0.0%) 2 (1.4%) 1 (0.7%) Moderate 9 (6.4%) 11 (7.5%) 10 (6.9%) 11 (7.4%) 9 (6.2%) Mild 18 (12.8%) 16 (11.0%) 16 (1.1%) 11 (7.4%) 11 (7.5%) Note: Treatment-emergent adverse events are those with an onset on or after the date of the first dose of study drug. 

1. A topical gel formulation comprising active ingredients of 1-1.5 wt. % clindamycin phosphate, 2.5-3.5 wt. % benzoyl peroxide, and 0.15-0.2 wt. % adapalene, in combination with a gelling agent, an additional agent which is a polyhydric alcohol, and water.
 2. The formulation of claim 1, wherein the active ingredients comprise about 1.2 wt. % clindamycin phosphate, about 3.1 wt. % benzoyl peroxide, and about 0.15 wt. % adapalene.
 3. The formulation of claim 2, wherein the formulation comprises a) about 1.2 wt. % clindamycin phosphate, b) about 3.1 wt. % benzoyl peroxide, c) about 0.15 wt. % adapalene, d) about 5 wt. % propylene glycol, e) about 1.75 wt. % carbomer homopolymer Type C, f) potassium hydroxide in an amount to provide a pH of 5-6, and g) water.
 4. A method of treating an inflammatory skin condition in a patient in need thereof, comprising administering to an affected area of the skin on at least a daily basis, a topical gel formulation according to claim
 1. 5. The method of claim 4, wherein the inflammatory skin condition is acne.
 6. The method of claim 5, wherein administration is once daily over a period of at least 4 weeks.
 7. The method of claim 6, wherein the treatment is more effective in treating acne than treatment with another formulation comprising active ingredients selected from the group consisting of (i) 1-1.5 wt. % clindamycin phosphate and 2.5-3.5 wt. % benzoyl peroxide, (ii) 2.5-3.5 wt. % benzoyl peroxide and 0.1-0.2 wt. % adapalene, and (iii) 1-1.5 wt. % clindamycin phosphate and 0.1-0.2 wt. % adapalene.
 8. A drug container, comprising a pump and a topical gel formulation according to claim 1, wherein the pump is calibrated to release a specific amount of the formulation each time the pump is pressed.
 9. A method of making a topical gel formulation according to claim 1, comprising i) providing the following premixes: a) Premix A comprising a dispersion of gelling agent in water, b) Premix B comprising a dispersion of benzoyl peroxide in polyhydric alcohol and water, c) Premix C comprising clindamycin phosphate in aqueous solution, d) Premix D comprising a dispersion of micronized adapalene in polyhydric alcohol and water, ii) mixing Premix A and Premix D, iii) admixing Premix B to the mixture of step ii, iv) admixing Premix C to the mixture of step iii, and v) adjusting the pH of the mixture of step iv to pH 5-6 to form a gel.
 10. (canceled)
 11. The formulation of claim 1, wherein the gelling agent is selected from the group consisting of hydroxypropylcellulose, hydroxyethylcellulose, carboxyvinyl polymers carboxyvinyl polymers crosslinked with allyl ethers of polyalcohols, carboxyvinyl copolymers, polyacrylates, acrylate copolymers, acrylamide/sodium acryloyldimethyltaurate copolymers, polyvinyl alcohols, polyethylene oxides, propylene glycol alginates, methylcellulose, hydroxypropylmethylcellulose, xanthan gum, carrageenan gum, and combinations thereof.
 12. The formulation of claim 1, wherein the gelling agent comprises carbomer homopolymer Type C.
 13. The formulation of claim 1, wherein the gelling agent is a crosslinked polymer comprising carboxy moieties and wherein the formulation further comprises a base selected from the group consisting of potassium hydroxide, sodium hydroxide and combinations thereof in an amount sufficient to deprotonate the carboxy moieties sufficiently to cause the gelling agent to thicken.
 14. The formulation of claim 1, wherein the amount of gelling agent is 1.5-2 wt. %.
 15. The formulation of claim 1, wherein a fraction of the benzoyl peroxide is undissolved, wherein the undissolved fraction of the benzoyl peroxide is homogeneously dispersed in the formulation, and wherein the undissolved fraction of the benzoyl peroxide has a mean particle size between 1 and 50 microns.
 16. The formulation of claim 15, wherein a fraction of the adapalene is undissolved and wherein the undissolved fraction of the adapalene is homogeneously dispersed in the formulation.
 17. The formulation of claim 1, wherein the adapalene and the benzoyl peroxide do not undergo any oxidation reaction with one another.
 18. The formulation of claim 1, wherein the polyhydric alcohol is selected from propylene glycol, ethoxydiglycol, polyethylene glycol, glycerol, and combinations thereof.
 19. The formulation of claim 1, wherein the formulation is free of additional agents as organic solvents other than the polyhydric alcohol.
 20. The formulation of claim 1, wherein the amount of polyhydric alcohol is 3-7 wt. %.
 21. The formulation of claim 1, wherein the formulation is free of ionic surfactants. 